Why do wait times remain high in WRH's emergency room? A Q&A with Dr. Saad

For people in Ontario waiting to see a doctor after being admitted to an emergency room, Windsor Regional Hospital’s Metropolitan campus continues to see the longest wait times compared to all other hospitals in the province.

That’s according to updated data from Health Quality Ontario which says patients at the Met campus wait an average of 5.1 hours before meeting with a doctor. That’s the highest in Ontario.

In comparison, the provincial average is just 2.1 hours.

CTV News Windsor’s Sanjay Maru spoke with Windsor Regional Hospital’s chief of staff Dr. Wassim Saad to learn more about what’s causing these long waits and what needs to be done to fix them.

This interview has been edited for clarity and length.

CTV News: What do you attribute the long waits to?

Dr. Saad: We know that wait times across the province and across the country are up right now. In fact, in some areas, there's been so much pressure that their emergency rooms have closed. Thankfully, that has not been the case here in Windsor.

We know that staffing issues are a big problem. This applies to our professional staff, physicians that work in the emergency room, nursing staff and all of our allied health staff. We know that, traditionally, in the summer months, the occupancy rate in the hospital is usually much lower. It gives people a chance to recharge and go on vacation and recuperate a little bit. But unfortunately, we're going into a summer month now in July, with occupancy rates that are over 100 per cent and that's putting a tremendous amount of stress and strain on our remaining staff that are working. There's tremendous burnout amongst our staff. There's no question about that.

Of course, with our in-patient volumes being what they are, it makes it harder for a patient who comes into the emergency room and who does need admission to actually get a bed. In many cases, we have patients sitting in the emergency room who have already been admitted to hospital, but can't get a physical bed. So they use up space in the emergency room, which then makes the flow and the workflow in the emergency room less efficient.

You also have patient factors. We know that, coming out of the pandemic, many patients have delayed their care. In some cases, patients were either not able to access walk-in clinics or their primary care and are presenting to the emergency room … Many of those cases are not truly emergencies that belong in an emergency room. But when someone comes to the emergency room, we can't turn them away before they're properly assessed and deemed to be safe for discharge.

CTV News: But why is Windsor Regional Hospital topping the list, compared to all other hospitals in Ontario? What issues are emerging at the local hospital that are not being seen or, perhaps, being seen less severely at other hospitals?

Dr. Saad: There's no question that Windsor Regional Hospital, and particularly the Met campus, has been underperforming with respect to wait times. That predates the pandemic. It's just that things are obviously much worse after the pandemic. It goes back to some of the struggles I've already mentioned.

Staffing is a big issue. We have always struggled with the number of emergency room physicians that we have. We’ve been in active recruitment for as long as I can remember. We're being as aggressive as we possibly can to recruit more ER doctors. Pre-pandemic, nursing and staffing issues were not much of a problem. Now, they are a problem. We are often so understaffed that we can't fill full shifts of nurses now.

There are many specialists as well who have not fully returned back to the office to be fully in-person and that's putting a strain also on the system. That’s because if they're doing a consultation virtually, and they can't tell whether a patient is sick enough or not, the advice is often for them to go to the emergency room.

The other problem locally that we've had in Windsor also is the availability of after-hours care and urgent care centers — any place where somebody could have a problem dealt with that night, instead of waiting until the next day … That's something I know the Ontario Medical Association has been working hard at with its members to try to increase the availability of after-hours care.

CTV News: You mentioned that the hospital is trying hard to recruit more ER nurses. Can you elaborate more on those efforts?

Dr. Saad: There are many hiring incentives that we're offering, both from a financial perspective and a return-of-service agreements, even referral programs where if you refer somebody who ends up coming to work with us, you could get financial incentive and a bonus there … In fact, we have 10 per cent more staff now than we did pre-pandemic. So that recruitment has never stopped and we're being as aggressive as we possibly can.

But what we're noticing, and this is not just a healthcare issue but an issue in most other sectors after the pandemic, is that a lot of people have either chosen early retirement, prefer to work virtually, elect to work in a hybrid model or are working part-time. So even though we've hired 10 per cent more than we had earlier, as a result of some of the retirements and part-time work and people trying to take on less work than they did pre-pandemic or during the pandemic, it's affecting our workforce.

CTV News: You also mentioned emergency rooms at other Ontario hospitals having to close for one reason or another. Do you ever foresee that happening at Windsor Regional Hospital?

Dr. Saad: I hope not. One of the things that's unique about our city is our geography. We know that for some of these other hospitals, they’re usually much smaller or are located near a bigger centre. So if they close, a patient that needs emergency services can drive 45 minutes in either direction and likely hit another emergency room.

That's not the case with us. Particularly, with the services that we provide at Windsor Regional Hospital, the next comparable emergency room where they would access resources would be London, and that's two hours up the 401. Detroit is not an option unless we transfer patients over there if we can't deal with the problem urgently. But we're the only game in town. For the community that we service, we have an obligation to stay open no matter what it takes.

I don't anticipate a scenario where we would have to close our emergency rooms or one of our emergency rooms. But no one can predict what's going to happen. If you don't have the personnel to keep an emergency room open, then you have to deal with the potential consequences of not having enough people to run it. For now, we're managing and we hope to keep it going as long as possible.